CALIFORNIA TUMOR TISSUE REGISTRY

"GENERAL PATHOLOGY"

Study Cases, Subscription A

March 2008

Culifornia Tumor Tissue Registry c/o: Department ofPatbology and Human Anatomy

Loma Linda University Scbool or Medicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 558-4788 FAX: (909) 558-0 188

E-mail: cnr@linklinc.com Web page: "~vw.cur.org

Web site & Case of tbe Month: www.cttr.org

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Target audience: Practicing pathologists and pathology residents.

Goal: To acquaint tl)e participant with the histologic features of a variety of benign and

malignant neoplasms and tumor-like conditions.

Objectives: The participant will be able to recognize morphologic features of a variety of benign

and malignant neoplasms and tumor-like conditions and relate those processes to pertinent references in the medi9al literature.

Educational methods and media: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing of selected references from the medicalliteratme.

Principal faeultv: Weldon. K. Bullock, MD Donald R. Chase, MD

CMECredit: Lorna Linda University School of Medicine designates this continuing medical

education activity for a maximum of2 hours of Category I of the Physician's Recognition Award of the American Medical Association.

CME credit is offered for the subscription year only.

Accreditation: Loma Linda University School of Medicine is accredited by the Accreditation

Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

Contributor : LLUMC Pathology Group (rr) Lorna Linda, CA

Tissue from: Submandibula r gland

Clinical Abstract: A 67 year old man presented with a left neck mass.

Gross Pathology:

Case No. 1 - March 2008 A

Accession #30557

The 244 gram, 10 x 6.5 x 5 em submandibular gland resection included a 6 x 4 x4 em cyst filled with brown fluid. The remaining parenchyma was uniformly brown-tan.

Contributor: Lester Thompson, M.D. Case No. 2 - March 2008 A Woodland Hills, CA

Tissue from : Sinonasal tract Accession #30581

Clinical Abstract: A 61 year old man presented with nasal obstruction and occasional episodes of epistaxis.

Direct visualization showed a mass in the nasal cavity without bony destruction. Biopsy led to severe bleeding. Prior to resection, an embolization was peformed.

Gross J>atbology: The polypoid nasal mass was 4 .S em in greatest diameter.

Contributor: LLUMC Pathology Group (mp) Lorna Linda, CA

Tissue from: Left kidney

Clinical Abstract:

Case No. 3 - March 2008 A

Accession #305 I 0

A 33 year old man had a history of abdominal and lower back pain. Ultrasound showed a solid enhancing left renal mass.

Gross Pathology: The 535 gram, 25.5 x 12.5 x 6.5 em nephrectomy specimen showed a 5.5 x 4.2 x 2.5 em thinly

encapsulated solid, trabeculated bright yellow mass with a central region of white fibrous tissue in the upper pole of the kidney.

Contributor: LLUMC Pathology Group (cz) Lorna Linda, CA

Tissue from: Right kidney

Clinical Abstract: This 4 year old boy had bilateral retroperitoneal masses.

Gross Pathology:

'

Case No. 4 - March 2008 A

Accession #30564

The I 07 gram, 7 x 4 x 4 ern right kidney partial resection contained multiple nodules up to 3.4 em in greatest diameter.

Contributor: Robert Zucb, M.D. Case No. 5 - March 2008 A Baldwin Park, CA

Tissue from: Stomach Accession #30540

Clinical Abstract: A 60 year old woman was found to have a gastric mass and underwent a partial gastric

resection.

Gross Pathology: The 5 em diameter resection specimen had an attached 8 x 6 x 4.2 em protruding mass, covered

by a thin layer of serosa. The cut surface was pink-white ' fish nesh ' textured, vaguely nodular and with a somewhat variegated cut surface.

Special Studies: Positive: C0117, Vimentin Negative: Pancytokeratin, EMA, Desmin, muscle specific actin, S l 00, smooth muscle actin

Contributor: LLUMC Pathology Group (rr) Lorna Linda, CA

Tissue from: Rctroperitoncum

Clinical Abstract :

Case No. 6 - March 2008 A

Accession #30573

A 50 year old man was found to have a large retroperitoneal mass.

Gross Pathology: The 7000 gram, 40 x 30 x 12 em globoid mass had a portion colon attached to one surface and

loops of small bowel entering and exiting the tumor. The yellow-tan tumor had a central hemorrhagic cavity and other areas of necrosis and hemorrhage.

Soecial Studies: Negative: S 100, CDII7 Pending

Contributor: LLUMC Pathology Group (rr) Loma Linda, CA

Tissue from: Retroperitoncum

Cliuicnl Abstract: A 77 year old man had a large retroperitoneal mass.

Gross Pathology:

Case No. 7 - March 2008 A

Accession #30558

The 3500 gram, 30 x 25 x 8 em composite resection included right kidney, right adrenal, right colon, portions of liver, of ileum, and of inferior vena cava. The main body of the tumor was 21 x 15 x 9 em with a geographic yellow-brown and red-tan coloration.

Contributor : LLUMC Pathology Group (kc) Case No.8 - March 2008 A Loma Linda, CA

Tissue from: Retroperitoneum Accession #30039

Clinical Abstract: A 60 year old man reported two months of abdominal pain. Radiographs showed a

retroperitoneal cystic mass encasing the right kidney

Gross Pathology: The 1654 gram 29 x 16 x 8 em composite resection specimen included right kidney and a 15.5

x 15 x 6.5 em partially necrotic gray-tan tumor that invaded the lower pole of the kidney. Most of the tumor was extra-renal, with a portion invading the psoas muscle.

Special Studies: Negative: Cytokeratin, S I 00, Desmin, Myogenin, HMB45, LCA, CD30, CD34 Positive: CD31

Cont ributor : LLUMC Pathology Group (mp) Loma Linda, CA

Tissue from: Righi maxilla

Clinical Abstract:

Case No.9 • March 2008 A

Accession #30572

This 60 year old man presented with upper respiratory pmblems and was discovered to have a right maxillary mass.

Gross Pathology: The 114 gram, 8 x 6 x 4 em right maxillary resection specimen had an 8 em fungating, friable

exophytic tumor replacing the entire posterior alveolar ridge and projecting inferiorly into the oral cavity, posteriorly into the nasal cavity and oropharynx, and superiorly involved the base of the maxillary sinus.

Special Studies: Positive: Cytokeratin (focal), EMA (focal) Negative: SlOO, HMB-45, desmin, myogenin

Contributor: M. Rose Akin, M.D. Fresno, CA

Tissue from: Ovary

Clinical Abstract :

Case No. 10 • March 2008 A

Accession #30550

A 55 year old woman complained of post-menopausal bleeding. Work up showed an enlarged right ovary.

Gross Pnthology: The right ovary was 5.3 x 4 x 2.8 em and had a smooth yellow-tan outer surface. The cut

surface showed a 4 em diameter soft yellow·tan to pink-tan mass composed of spongy tissue with small Ouid-filled cysts up to 0.4 em in greatest diameter.

Soecial Studies: Positive: Inhibin Negative: Chromogranin, synaptophysin, CD99

CALIFORNIA T UMOR TISSUE REGISTRY

GENERAL PATHOLOGY

Minutes- Subscription A

March, 2008

SUGGESTED READING (Gcncrul TOtliCS from Recent Literature):

Sarcoma. Skubitz KM, D'Adamo OR. Mayo Clin Proc 2007; 82:1409-1432. Clinical Significance ofCulrures Collected From Fine-Need le Aspirmion Biopsy. Granville LA, Lauciricn R. nnd

Verstovsek G. Diagn Cytopa~hol2008; 36:85-88. Multimarker Phenotype Predicts Adverse Survival in Patients with Lymph Node-Negative Coloreclal Cancer. Zlob I,

Minoo P, et al. Cancer 2007; 112:495-502. Oral Non-Uodgkin's Lymphoma. Review of the Literature and W()(ld Health Organization Classification with

Reference to 40 Cases. Kemp S, Gallagher G, et al. Oral Surg Oral Med Oral Pothol Oral Radio/ Endod 2008;

105:194-201. Application of Flow C)'lometry for Biomarker-B._~ Cervical Cancer Cells Detection. Ling J. Wiederkehr U, ct al.

Dlag11 Cytopathol2008; 36:76-84.

Cali fornia Tumor Tissue Registry c/o: Department of Pathology and !-Iuman Anatomy

Lorna Linda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 558-4788 FAX: (909) 558-0188

E-mail: cur@linklinc.com Web site & Case of the Month: www.cttr.org

Case 1:

Case2:

Case3:

Case 4:

Case 5:

Case 6:

Case 7:

Case 8:

Case 9:

FILE DIAGNOSES

CTTR Subscription A March 2008

Pleomorphic adenoma (benign mixed tumor), sub mandibular T-55320, M-89400

Glomangiopericy toma (sinonasal-type hemangiopericytoma), sinonasal tract T-2X120, M-91501

Renal ce ll carcinoma (conventional/clear type), kidney T-7 1000, M-83 123

Nephroblastoma (Wilm's tumor), kidney T-72010, M-89603

Gastrointestinal s tromal tumor, stomach T-63000, M-88903

High grade sarcoma of retroperitoneum T-Y4600, M-90403

Well d ifferentiated liposarcoma, retroperitoneum T-Y 4600, M-88513

Angiosarcoma (epithelioid subtype), retroperitoneum T-7 1000, M-9 1203

High grade spindle cell malignancy, favor monphasic synovial sarcoma over spindled carcinoma, maxilla

T-10170, M-904 13

Case 10:

2

Granulosa cell tumor, ovary T-87000, M-86203

CITR. March 2008 "t-.·1jnutc:s'' (Subscription A}

Case No. 1, Accession No. 30557

Alameda (Alameda County Medical Center) • Pleomorphic adenoma Long Beach (Long Bench VA Hoslli.ul.l) • Pleomorphic adenoma (benign mixed twnor) (6) Oakland • Benign mixed tumor vs. basaloid adenoma

March 2008

Oxnard CSt. John's Regional Medical Center) · Pleomorphic adenoma (2); Carcinoma ex-pleomorphic adenoma (I) San Diego • Pleomorphic adenoma, submandibular gland San Diego CNaval Medical Center) • Benign mixed tumor (pleomorphic adenoma) Santa Rosa Mcmorjal Hospital) • Pleomorphic adenoma (2); mixed type (I) Woodland Hills · Pleomorphic adenoma Alabama (Baptist Medical Center) • Pleomorphic adenoma Alabama CSt. Vincent's Hospital) · Pleomorphic adenoma Alabama CUAB) · Pleomorphic adenoma Colorado · Pleomorphic adenoma florida Olte Pathology Group) · Pleomorphic adenoma Georgia (Medical College of Georgia) • Pleomorphic adenoma Indiana (St. Joseph Hospimll · Pleomorphic adenoma (mixed rumor) ( I); Pleomorphic adenoma ( I) Iowa CWinneshiek Count\• Medical Hospjtall · Mixed tumor Marxland (Washington DC Group) • Benign mixed tumor Mnssachuset!s CTufis-New England Medical Center) • Pleomorphic adenoma Mjssouri (Missouri Delta Medical Center) • Pleomorphic adenoma focal area suggest carcinoma ex-pleomorphic Ncyuda (Sunrise Hospilall • Pleomorphic adenoma (benign mixed tumor) New York !Long lslnnd Jewish Medjcal Center) • Benign mixed tumor New york (Sr. Luke's-Rooscvelt Hospital) • ·cystic mucoepidermoid carcinoma New York (Stony Brook Universitv Medical Center\ • Pleomorphic adenoma Ohjo CSt. Elizabeth Health Center) • Pleomorphic adenoma Pennsvlvania (Mage<; Women's Hospital) · Cellular adenoma Australia (Royal HObart Hospital) • Pleomorphic adenoma submandibular gland Hong Kong {Kwong Wah Hospital\ • Pleomorphic adenoma Saudi Arabia !King Pahad National Guard Hospital) • l'leomof]lhic adenoma Saudi Arabia (King Fnisal Specialty Hospital) • Submandibular glands, pleomorphic adenoma Unjted Kingdom (John Radcliffe Hospiln!l • Submandibular gland, pleomorphic adenoma

Cast t - Diagnosisi Pleomorphic adenoma (benign mixed tumor), submandibular

1'·55320, M-89400

Case I • References: Pas OK and Anim JT. Pleomorphic Adenoma of SaliVtlJ')' Gland. To What Extent Does Fine Needle Aspiration

Cytology Reflect Histopathological Features? Cytopatho/2005; 16(2):65-70. Rapidis AD, Stavrianos S Lagogiannis G, et al. Tumors of the Submandibular Gland. Clinicopathologic Analysis or23

Patients. J Oral Maxillofac Surg 2004; 62(1 0): 1203·1208. Hong KH and Yang YS. Intraoral Approuch tor tl1e Treatment of Submandibular Salivary Olund Mixed Tumors. Oral

Onco/2007. Munir N and Bradley PJ. Pleomorphic Adenoma of the Submandibular Gland. An Evolving Change in Practice

following Review of a Personal Case Series. Eur Arclr Otorhino/aryngo/2007; 264(12): 1447-1452. Munir N and Bradley PJ. Diagnosis and Management of Neoplastic Lesions of the Submandibular Triangle. Oral

Onco/2008; 44(3):25 1-260.

Case No. 2, Accession No. 30581 March 2008

A)pmeda (Alameda County Medical Center) · Hemangiopcricytoma, s inonasnl type

CTTR. Mart:b 2008 "Minulcs·· (Subscription A) )

Long Beach (Long Beach VA Hospital) - Gl.;>mangiopcricytoma (hemangiopericytoma-like tumor) (6) Oakland - Hemangiopericytoma Oxnard (St. John 's Regional Medical Center) - Hemangioendothelioma (3) San Diego - Solitary fibrous tumor, cellular, sinonasal tract San Diego (Naval Medical Center) -· Sinonasal hemangiopericytoma (glomangiopcricytoma) Santa Rosa Memorial Hospital) - Glomangiopericytoma (sinonasal-type hemangiopericytoma) (l); Spindle cell

neoplasm, rule out melanoma, Schneiderian papilloma (I); Schneiderian papilloma (I) Woodland Hills - Glomangiopericytoma · Alabama (Baptist Medical Center) - Hemangiopericytoma Alabama CSt. Vincent's Hospital) - Nasal hemangiopericytoma Alabama IUABl - G-lomaugiopericytoma (sinonasal-type hemangiopercytoma) Colorado - Hemangiopericytoma Florida IThe Pathology Grouol. - Hemangiopericytoma Geomia (Medical College of Georgia) - Inverted papilloma, onwcytic type Indiana (St. Joseph Hospitall - Sinonasal hemangiopericytoma (2) l.owa (Winneshiek County Medical Hospital\ - Inverted papilloma Marvland (Washington DC Group) - Kaposi's sarcoma . Massachusetts (1\tfts-New England Medical Center) - Aemangiopcricytoma Missouri (Missouri Della Medical Center) - Hemangiopericytoma (APC) Nevada (Sunrise Hospital) - Sinonasal hemangiopericytoma New York <Long Island Jewish Medical Center) - Hemangiopericytoma New York (St. Luke's-Roosevelt Hospital) - Glomangiopericytoma New York CStonv Brook University Medical Center) - Hcmangiopericytoma, sinonasal type Ohio (St. Elizabeth Health Center) - Hemangiopericytoma-l ike tumor·ofnasal passage/hemangiopericytoma Pennsylvania (Maeee Women's Hospital) - Hemangiopericytoma, sinonasal iype (glomangiopericytoma) Australia (Royal Hobart Hospital) - Haemangiopericytoma-like tumor of na~al passages Hong Kong (Kwong Wah Hospital) - Hemangiopericytoma-like tumour Saudi Arabia (King Fahad National Guard Hospital) -· Hemangiopericytoma Saudi Arabia (King Faisal Specialty Hospital) • Sinona.~al tract, sinonasal hemangiopericytoma United Kingdom (John Radcliffe Hospitall - Sinonasal glomangiopericytoma

Case 2 - Diagnosis: Glomangiopericytoma (sinonasal-type hemangiopericytoma), sinonasal tract

T·2Xl20, M-91501

Case 2 . References: Thompson LD. Sinonasal Tract Glomangiopericytoma (Hemangiopericytoma). Em· .Nose Throat J 2004;83( 12):807. Thompson LD, Miettinen M, Wenig BM, et al. Sinonasai-Type Hemangiopericytoma. A Clinicopathologic and

lmmunophenotypic Analysis of 104 Cases Showing Perivascular Myxoid Differentiation. Am J Surg Patho/2003; 27(6):737-749.

Li XQ, Hisaoka M, Morio T, et al. Intranasal Pericytic Tumors (Glomus Tumor and Sinonasal Hemangiopericytoma­Like· Tumor). Report of Two Cases with ReYiew of the Literature. Parhollnt 2003; 53(5):303-308.

Kuo FY, Lin HC, Eng HL, et al. Sinonasal Heniangiopericytoma-Like Tumor with True Pericytic Myxoid Differentiation. A Clinicopathologic and Immunohistochemical Study of Five Cases. Head Neck 2005; 27(2): 124-129.

Wilson T, Hellquist HB, RayS, et al. Intranasal Myopericytoma. A Tumour with Perivascular Myxoid Differentiation. The.Changing Nomenclature for Haemangiopericytoma. J Laryngol Oto/2007; 121(8):786-789.

Gengler C. and Ouillou L. Solitary Fibrous Tumour and Raemangiopericytoma. Evolution of a Concept. HisiOpathol 2006; 48( 1):63-74.

Case No. 3, Accession No. 30510 March 2008

Alameda (Alameda County Medical Center) - Renal cell carcinoma Long Beach (Long Beach VA Hospital) - Renal carcinoma, clear cell type (6)

4 CITR, March 2008 "Minu1es'' (Subsctiption.J-\)

Oakland • Renal oncocytoma vs. clear cell carcinoma Oxnard <St. John's Regional Medical <&mer} • Renal cell carcinoma, clear cell (I); Renal cell carcinoma. Grade I (I);

Renal cell carcinoma (I) San Qicgo · Renal cell carcinoma, clear cell type San Diego <Naval Medical Center} . Clear cell renal cell carcinoma Santa Rosa Memorial Hospital) • Renal cell carcinoma, clear cell type (3)

WOO<! land Hills • Renal cell carcinoma, clear cell type, low grade Alabama <Baptist Medical Center} · Renal cell carcinoma, clear cell type Alabama {St. Vincent's Hosoitall • Rennl cell carcinoma, clear cell type Alabama (UAB) • Renal cell carcinoma, clear celll)'pe, Fuhnnan, grade I

Colorado · Clear cell (conventional) renal cell carcinoma florida Cfhe Pathology Group) • Renal cell carcinoma, clear cell type Georgia (Medical College of Georgia) • Conventional clear cell renal cell carcinoma Indiana {St. Joseph Hospital) · Renal cell carcinoma, clear cell variant (2) Iowa fWinneshiek County Medical Hgspilnll · Cleer cell carcinoma Mgryland (Washington DC Group) • Renal cell carcinoma Massachuset1s <Tufts-New Eneland Medical Center) · Renal cell carcinoma, conventional type Missouri <Missouri Delta Medical Center) • Xanlhogranulomatous pyelonephritis Nevada (Sunrise Hospjtal) • Renal cell carcinoma, clear cell type New York CLong Island Jewish Med ical Center) · Renal cell carcinoma New York (St, Luke's·Roosevelt H~!:illilnll • Ren~l cell carcinoma New York (Stony Brook Universitv Medical Center) · Renal cell carcinoma, clear cell type, grade I Objo {St. Elizabeth Health Center) · Renal cell carcinoma Pennsylvania (Magee Women's Hospitall • Reoal cell carcinoma (clear cell) type Australia {Royal Hobqo Hospital) • Clear cell renal cell carcinoma Hong Kong (Kwong Wah Hospitall - Clear cell carcinoma Saudi Arabia (King l'ahad National Guard Hosp·itall • Renal cell carcinoma Saydi Arabia {King fajsal Specialty Hospital) • Renal cell carcinoma, Furhman, grade 2, left kidney United Kingdom (John Radcliffe Hosoilal) • Conventional (clear cell) renal cell carcinoma, kidney

Case 3. Diagnosis: Renal cell carcinoma (convcntionaVclear celll)lpc), kidney

T-71000, M-83 123

CQ.~e 3 ~ ReferencYSj Cheville JC, Lohse CM, Zincke H, et al. Comparisons of Outcome and Prognostic Features Among Histologic

Subtypes of Renal Cell Carcinoma. Am J Surg Patho/2003; 27(5):612-624. Soller MJ, Kullcndorff CM, Bekassy AN, et at Cytogenetic Findings in Pediatric Renal Cell Carcinoma. Cancer

Genet Cytogenet 2007; 173(1 ):75-80. Svcc A and Velensku Z. Renal Epithelioid Angiomyolipoma. A close Mimic of Renal Cell Carcinoma. Report of a

Case and Review of the Literature. Pat hot Res Proct2005; 200:851-856. Upton MP, Parker RA, Youmans A, et al. Histologic Predictors of Renal Cell Carcinoma Response to lnterleukin-2

Bases Therapy. J lmmunother 1997 2005; 28(5):488-495. Grignon DJ and Che M. Clear Cell Renal Cell Carcinoma. Clin Lab Med200S; 25(2):305·316.

Case No. 4, Accession No. 30564

Alam¢a (Alameda County Medical Center) • Nephroblastoma (Wilm's tumor) Long Beach (Long Beach VA Hospital! • Wilm's tumor (6) Oakland • Wilm's tumor Oxnard fSt John's Regional Medical Center) · Wilm's tumor (3)

CTT'R, March 2008 -M•nul<s- (Subscriplion A)

March 2008

l

San Diego - Ncphroblastoma San Diego (Naval Medical Center) - Wilm's tumor Santa Rosa Memorial HoslliJrul - Nepnroblastoma (Wilm's tumor) (3) Woodland Hills - Nephrolilastorna Alabama CBaptist Medical Center) - Wilrn's rumor Alabama (St. Vincent's Hospital) - Wilm 's tumor Alabama CUAB) - Nephroblastoma (Wilm 's tumor) Colorado - Nephroblastoma Florida C!'he Pathology Group) - Nephroblasroma Ueorgia (Medicai .College of Georgia) - Neuroblastoma Indiana (St. Joseph Hospital) - Nephroblastoma (2) Iowa {Winneshiek County Medical Hospital) - Wilm's tumor Maryland (Washington DC Group) - Wilm's tumor Massachusetts (Tufts-New England Medical Center) - Wilm's tumor Missouri (Missouri Delta Medical Center) • Wilm 's tumor Nevada (Sunrise Hospital) - Wilm's tumor New York (Long Island Jewish Medical Center} • Wilm:s tumor New York (St. Luke's-Roosevelt Hospital) - Wilm's tumor New York (Stony Brook Universjty Medical Center) - Wilm's tumor Ohio (St. Elizabeth Healtb Center) - Wilm's tumor (blastema! predominant) Pennsvlvania (Magee \V'omen 's.Hosr.ital) - Blastema-rich Wilm's rumor Australia CRoyal Hoban Hospital) - Nephroblastoma Hong Kong (Kwong Wah Hospital) - Neuroblastoma Saudi Arabia CKing Fahad National Guard Hospital) - Wilm's tumor Saudi Arabia CKing Faisal Specialtv Hospital\ - Wilm's tumor, kidney United Kingdom (John Radcliffe Hospital\ - Nephroblastoma

Case 4 · Diagnosis: Nephroblastornil (Wilm's tumor), kidney

T-72010, M-89603

Case 4 - References: Khoury JD. Nephroblastie Neoplasms. Clin Lab Med 2005; 341-361. Ghanem MA vart Ste<nbrugge GJ, Nijrnan RJ, ·el al. Prognostic Markers in Nephroblustom(a (Wilms' Tumor). Urology 2005;

65(6): I 047-1054. Mitry E, Ciceolallo L, Coleman MP, et al. Incidence of and Survival from Wilm's Tumour in Adults in Europe. Data from the

EUROCARE Study. Eur J Cat:cer 2006; 42(14):2363-2368. Blakely ML, Shamberger RC, Norkool P, cl al. Outcome of Children with Cystic Partially Differentiated Nephroblastoma Treated

With or Without Chemotherapy. J Pediatr Surg 2003; 38(6):897-900. Guertl B, .Ratschek M. Hanns D. et a l. Clonnlity and Loss of Heter(lzygosity of WT Genes nrc Early Events in the Patholgenesis of

NephroblastomltS. /fum Patho/2003; 34(3):278-281.

Case No. 5, Accession No. 30540

Alameda (A lameda Ccuntv Medical Center) -Gastrointestinal stromal nunor (GIST) Long Beach (Long Beach YA 1-Jospitall - Gastrointestinal stromal tumor (6) Oakland • Gastrointestinal stromal tumor Oxnard CSt John's Regional Medical Center) • Gastrointestinal stromal tumor (3) San Diego - Gastrointestinal stromal rumor, intermediate risk, stomach San Diego (Naval Medical Center) - Epithelioid gastrointestinal stromal tumor Santa Rosa Memorial Hospital) - Gastrointestinal stromal tumor (GIST) (3) Woodland Hil.ls - Gastrointestinal stromal tumor Alabama (Baptist Medical Center) • Gastrointestinal stromal tumor Alabama (St. Vincent's Hospital) - Gastrointestinal stromal tumor (uncertain malignant potential) Alabama CUAB) - Gastrointestinal stromal tumor of undetermined malignant potential Colorado - Gastrointestinal stromal rumor

Marcb 2008

6 CTTR, Marth 2008 .. Minutes"' (Subsc.ription A)

Florida <The Patholoey Group) - Gastrointestinal stromal tumor Georgia (Medical Colleee of Georgia) - Gastrointestinal stromal tumor Indiana CSt. Joseph Hospital} - Gastrointestinal stromal tumor (2-) Tow a CWlnneshiek County Medical Hospital) - Gastrointestinal stromal rumor Man•land <Washinetou DC Group) - Epithelioid gastrointestinal stromal rumor Massachusetts CTtifts-New England Medical Genter) - Gastrointestinal stromal nun or Missouri CMissomi Delta Medical Center) - Gastrointestinal stromal rumor Nevada (Sunrise Hospital} - Gastrointestinal stromal tumor New York CLong Island Jewish Me<lical Center) - Gastrointestinal stromal tumor New York (St. Luke's-Roosevelt Hospital) - Gastrointestinal stromal tumor New York (Stony Brook Universitv Medical Center) - Gastrointestinal stromal tumor Ohio CSt. Elizabeth Health Center) - Gastrointestinal stromal tumor Pennsylvania (Magee Women's Hospital} - Gastrointestinal stromal tumor Australia (Royal Hobart Hospital} - Gastrointestinal stromal tumor with risk of aggressive behavior Hong Kong (Kwong Wah Hospital} - Gastrointestinal stromal tumor Saudi Arabia CKing Fahad National Guard Hospital) - Gastrointestinal stromal ntmor Saudi Arabia CKing Faisal Spe.cialtv Hospital) • Gastroimcstinal stromal mmor, stomach United Kinedom (John Radcliffe Hospital) - Epithelioid gastrointestinal stromalnnnor

C•se 5- Diagnosis: Gastrointestinal stromal tumor, stomach

T-63000, M-88903

Case 5 - References: Chal<ipantelis P, Sail a C, Karoumpalis I, ct al. Endoscopic Ultrasound·Guide<l f ine Needle Aspiration Biopsy in the Diagnosis of

Gastrointestinal Stromal Tumors of the Stomach. A Study of 17 Otses. J Gastrointeslin Liver Dis 2008; 17( I): 15·20. Uppai N, Pule T, Nemeth T, Benedek d, et al. Keratin·Postivie Gastrointestinal Stromal Tumor of the Stomach Mimicking Gastric

Carcinoma. Diagnosis Conflnned by C·Kit Mutation Analys.is. Diagn Mol Patho/2008. Misclli F, Conca E, ·casicri P, et al. A Sporadic Multiple GIST with Unusual Pllthologjc, Molecular, and Genetic Peatures. Am J

Surg Patho/2008; 32(2):340-341. Braconi C, Bracci R, Bearzi let al. KIT and PDGPRalpha Mutations in t04 !'alien" with Ga.<troimestinal Stromal Tumor.; (GISTs).

A Population·Based Study. Ann Onca/2008; 19(4):706-71 0.

Case No. 6, Accession No. 30573 March 2008

Alameda (Alameda Countv Medical Center) • Sarcoma, NOS Long Beach (Long Beach VA Hospital) - Leiomyosarcoma (6) Oakland - Liposarcoma (dedifferentiated) vs. leiomyosarcoma Oxnard (St. John's Reeional Medical Center) - Sarcoma (3) San Die eo - Malignant peripheral nerve sheath tumor, retroperitoneum San Dieeo CNaval Medical Center) • High grade sarcoma Santa Rosa Memorial Hospital) - Sarcoma, probably leiomyosarcoma (I); High-grade sarcoma, probably fibrosarcoma

(2) Woodland Hills - Leiomyosarcoma Alabama (Baptist Medical Center) - Desmoplastic small round cel"l tumor Alabama (Stc Vincent's Hospital) - High grade synovial sarcoma Alabama CUAB) - Leiomyosarcoma, epithelioid variant, high grade Colorado - Poorly differentiated malignancy, favor leiomyosarcoma Florida CTite Patholoev Group) - Spindle cell malignant neoplasm, favor MPNST Georeia (Medical College of Georgia) - MPNST Indiana (St. Joseph Hospital) - Dedifferentiated liposarcoma (I); Malignant spindle cell tumor (do specials) Iowa CWinneshiek County Medical Hospital) - Fibrosarcoma Marvland (Washington DC Groue) - High grade sarcoma/leiomyosarcoma Massachusetts (Tufts-New England Medical Center) - Desmoplastic small round cell tumor Missouri (Missouri Delta Medical Center) - Malignant fibrous histiocyto·ma Nevada (Sunrise Hospital) - Malignant gastrointestinal stromal tumor

CTTR. March 2008 ;.Mimnes"' (Subscripti<)n A) i

New York CLoog Island Jewish Medical Center! • Sarcoma, NOS, favor fibrosarcoma New York CSt. Lukc's-Rooseve!t Hospitall • High grade sarcoma, NOS New York CS19ny Brook Universitv Medical Center) • Malignant peripheral nerve sheath tumor Ohio CS!. Eli7,8bcJh Health Center) . High-grade sarcoma, rio cxtraskeletal mesenchymal chondrosarcoma Pennsylyqoja (Magee Women's Hosoitall - Leiomyosarcoma Ausnalia fRoyal Hoban Hospital) - Leiomyosarcoma, pending results of immunohistochemical staining Hong Kong <Kwong Wah Hospital) - Leiomyosarcoma Saudi Ambja (King Fahad National Guard Hospitall - High grade sarcoma favoring MPNST Saudj Ambja (J<jng Faisal Specialty Hospitall - Fibrosarcoma, retroperitoneum United Kjngdom Qohn Radcliffe Hospital) - Pleomorphic sarcoma, NOS

Cue 6- Diagno~is: High grnde sarcoma or retroperitoneum

T-Y4600, M-90403

Directors Note: Additional studies ·could include EMA and CAM5.2 (to rule out synovial sarcoma). drc

CA~e 6- Rcf(jrences: Raut CP and Pistcrs PW. Retroperitoneal Sarcomas. Combincd·Modolity Treatment Approaches. J S1<rg Onco/2006; 94{1):81-87. Percc< EA. Outicrre-t JC, Moffat FL, et at Retroperitoneal and 'I' Neal Sarcomas. Prognosis Depends Upon Type Not Location. Ann

Surg Onco/2001; 14(3):1 114·1 122. Mendenhall WM, Zlotccki RA, Hochwald SN, et al. Retroperitoneal Son Tissue Sarcoma. Concu 2005; I 04(4):669-675. Fisher C. Folpe AL, ttoshimoto H, ot al. Intra-Abdominal Synovial Sa~oma. A Clinicopadtological Study. 1/istop(l/lro/ 2004;

45(3):24S-2S3. Alldinger I, Yonc Q, Pilarsky C, et al. Retroperitoneal son Ti$$UC Sa«omas. Prognosis and Treatment of Primory and Recum:nt

Oiscasein !17 P111iems. Anticancer Res 2006: 26(28): 1577-1 S81.

Case No. 7, Accession No. 30558

Alameda CAiamsda County Medical Center) • LipO$~rwma, well-differentiated Long Beach (l.ong Beach VA Hospital) • Well -differentiated liposarcoma (6) Oakland • Liposarcoma Oxnard CSt. John's Regional Medical Center) • Liposarcoma (3) San Diego • Well-differentiated (sclerosing) liposarcoma, retroperitoneum San Diego (Nayal Medical Center) - Liposarcoma, NOS

Murch 2008

Sanlll Rosa Memorjal Hospital) - Well-differentiated liposarcoma (I}; Liposarcoma (I); Myxoid liposarcoma ( I} Woos!land !!ills • Well-differentiated liposarcoma Alabama <BaOljst Mes!ical Center) • Well-differentiated liposarcoma Alabama CSt. Vjneent's Hospjtall • Well-differentiated myxoid lipo$3rcoma Alabama CUABl • Well-differentiated liposarcoma Colorado - Well-differentiated liposarcoma Florida (The Pathologv Group) - Liposarcoma, well-differentiated Georgia (Mcdjcal College of Georgia) - Liposarcoma Indiana (St. Joscr.b Hospital\ - Liposarcoma, wcll-diffcrcnliatcd (I); Liposarcoma (I) !own CWjnnesb jek Countv Medical Hospit!!ll - Liposarcoma Marvland CWnsh!ngton pc Group) • Well-differentiated liposarcoma/atypical lipoma Massachuscns CTuOs-Ncw England Medical Center) - Liposarcoma Missouri (Mjssourj Qclta Medical Center) • Pleomorphic lipoma Nevada (Sunrise Hospital) - Well-differentiated liposarcoma New York {Long Island Jewish Medical Center) • Liposarcoma New YorkCS!. Luke's-Roosevelt Hosoitall • Pleomorphic liposarcoma New York <Stony Brook Universitv Medical Center) - Well-differentiated liposarcoma Ohio IS(. Eljzabe(b Health Center) - Liposarcoma (well-differentiated) Pennsylvania (Magee Women's Hospital) - Liposarcoma, well-differentiated AuS:lrlllia <Royal Hoban Hospital) • Well-differentiated (sclerosing) liposarcoma

8 CTfR. Marth 200$ .. Minutes .. (Subscr.ptlon A)

Hong Kong (Kwong Wah Hospital) - Well-differentiated liposarcoma Saudi Arabia (Kjng Fnbad National Guard Hospital\ - Liposarcoma Saudi Arabia (Kjng Fajsal Specialty Hospital\ - Liposarcoma, retroperitoneum United Kingdom (John Radcliffe Hospital) - Well-differentiated liposarcoma

Case 7- Diagnosi!: Well differentiated liposarcoma, retroperitoneum

T-Y4600, M-88513

Case 7- References: Chouoiry CJ, Abdui-Knrim I'W, MacLennan GT, et at. Retroperitoneal Liposarcoma. J Uro/ 2007; 177(3):1 145. McCallum OJ, Burke JJ. Childs AJ, et at. Retroperitoneal Liposarcoma Weighing Over One H<mdred Pounds with Review or the

Literature. Gynecol Ont·ol 2006; I 03(3): I I 52- I 154. Fabre-Cuillcvln E, Coindrc JM, Somcrhausen NdeS. et al. Retroperitoneal Liposarcomas. Follow-Up Analysis ofDcdifferentiaiion

Atlcr Clinicopllthologic reexamination of 86 Liposarcomas and Malignant Fibrous Histioctyomas. Cancer 2006: 106( 12):2725-2733.

SingerS, Antonescu Cit Riedel E. ct at. Histologic Subtype ond Margin of Resoclion Predict PatteJ'n of Recurrence and Survival for Rctroperilonenl l..iposarcoma. Ann S11rg 2003; 238(3):l58-3 70.

Gronchi A, Casali PG, Fiore M, et al. Retroperitoneal Soft Tissue Sarcomas. Patterns of Recurrence in 167 Patients Trc:ated nt o Single ln.stitution. Canctr 2004; I 00(11 ):2448-2455.

Case No. 8, Accession No. 30039 March 2008

Alameda (Alameda County Medical Center) - Angiosarcoma Long Beach (tong Beach VA Hospital) - ~figh grade angiosarcoma (6) Oxnard (St. John 's Regional Medical Center) - Kaposi's angiosarcoma ( I); Vascular sarcoma, angiosarcoma (I); High

grade angiosarcoma, retroperitoneum ( 1) San Diego - Angiosurcomu, retroperitoncum San Diego (Nqyul Medjcal Center) - Poorly differentiated angiosarcoma Santa Rosa Memorial Homitnll - Angiosarcoma, epithelioid type ( I); Angiosarcoma (2) Woodland !!ills - Angiosarcoma Alabama <Baptist Medical Center) - Angiosarcoma Alabama (St. Vinccot's Hospital) - Poorly differentiated epithelioid angiosarcoma Alabama CUABl - Angiosarcoma, epithelioid variant Colorado • Hemangiopericytoma Florida <The Pathology Group\ - Angiosarcoma, poorly differentiated Georgia CMe!ljcal College of Georgia) - Angiosarcoma Indiana (St. Joseph t!osojta!l • High grade angiosarcoma (I); Angiosarcoma vs. malignant angiomyolipoma (I) Iowa (Winneshiek County Medical HospitaD - Poorly differentiated carcinoma Marvland CWashinroon DC Group) - Angiosarcoma Massachusetts (Tufts-New England Medical Center) - Angiosarcoma Missouri CMissouri Delta Medical Center) - Liposarcoma Nevada (Sunrise tlospital) - Angiosarcoma, high grade New York (Long Island Jewish Medical Center) - Angiosarcoma New York (St. Lukc's-Roosevelt Hospital\ - Angiosarcoma New York !SIOOy Brook University Medical Center) - Angiosarcoma Ohio (St. El!ir,abclh Health Center) - Angiosarcoma Pennsylvania (Magee Women's Hospital\ - Angiosarcoma Australia <Royal !!obart Hospjtall - Epithelioid anr,iosarcoma rclroperitoneum Hong Kong <Kwong Wah Hospjtal\ - Angiosarcoma Saudi Arabia (King fahad National Guard Hospjtal) - Angiosarcoma Saudi Arabia £Kjng Faisal Soecialty Hospital) - Angiosarcoma, retroperitoneum United Kingdom <Jolm Radcliffe Hospital) - High-grade angiosarcoma

CITR. Mnn;h 2008 .. Minu1es" (Substription 1\) 9

Case 8 - Diagnosis: Angiosarcoma(cpithclioid subtype), rctropcritoncum

T-71000, M-91203

Case 8 · References:

..

Brightman LA, Demierre Ml' and Byers HR. Macrophage-Rich Epithelioid Angi<>sarcoma Mimicking Malignant Melanoma. J Cutan Patho/2006; 33(1):38-42.

Gagner JP, Vim' JH, and Yang GC. Fine-Needle Aspiration Cytology of Epithelioid Angiosareoma. A Diagnostic Dilemma. Diagn Cytopal/lo/ 2005; 33(6):429-433.

Klijanicnko J, Caillaud JM, Lagace R, ct al. Cytohistologic Correlations in Angiosarcoma Including Classic and Epithelioid Variants. lnstitut Curie's llxperience. Diagn Cytopotho/2003; 29(3): 140-145.

Allison KH, Yeder 81, Bronner MP, et al. Angiosarcoma Involving the Gastrointestinal Trucl. A Series 01' Primary and Metastatic Cases. Am JSurg Patho/2004; 28(3):298·307.

Dcyrup AT and Weiss SW. Grading of Soft Tissue Sarcomas. The Challenge of Providing Precise Information in an lmpre<ise World. ffistopotho/2006; 48( I ):42-50.

Case No. 9, Accession No. 30572 March2008

Alameda (Alameda County Medical Centeri - Spindle cell carcinoma, poorly differentiated Lon~ Beach !Long Beach VA Hospital\ - Poorly differentiated spindle cell squamous carcinoma, sarcomatoid type (I);

Spindle cell carcinoma vs. monoatrophic (3); Sarcomatoid carcinoma synovial sarcoma (2) Oakland - Spindle cell carcinoma Oxnard 1St. John's Regional Medical Center) • Sarcoma (1); Chordoma? (1); Malignant fibrous histiocytoma (I) San Diego • Synovial sarcoma, maxilla Sjl!) Diego (Naval Medical Center) - Fibrosarcoma Sjl!)ta Rosa Memorial Hospital) - Spindle cell (sarcomatoid) squamous cell carcinoma (I); Malignant neoplasm,_

undiffcrcnliatcd, cortsistent with squamous cell carcinoma or synovial sarcoma (I); Spindle cell squamous cell carcinoma ( 1)

Woodland Hills - Spindle cell squamous cell carcinoma Alabama (Baptist Medical Center} - Monophasic syoovial sarcoma Alabama (St Vincent's Hospital) - Synovial sarcoma Alabama (UAB) - Spindle cell carcinoma Colorado - Spindle cell carcinoma Florida (The Pathology Group} - Spindle cell malignant neoplasm, favor synovial sarcoma Georgia (Medical Colle~e of Georgia} • Spindle cell squamous cell carcinoma Indiana (St. Joseph Hospital) • Spindle cell carcinoma (2) Iowa (w'inneshiek Cgunty Medical Hospital) - Squamous carcinoma Maryland (Washington DC Group) - Spindle cell carcinoma Massachusetts (Tufts-New England Medical Center} - Spindle cell carcinoma Missouri (Missouri Delta Medical Center) - Spindle cell malignant tumor, liposarcoma Nevada (Sunrise Hospital) - Spindle cell carcinoma New York ·CLone Island Jewish Medical Center} - Sarcomatoid carcinoma New York 1St. Luke's-Roosevelt Hospital) • Synovial sarcoma New York !Stony Brook University Medical Center) • Fibrosarcoma Ohio 1St. Elizabeth Health Center) • Spindle cell carcinoma Pennsylvania (Magee Women's Hospital) • Spindle cell c-arcinoma Australia (Royal Hobart Hospital) • Spindle cell squamous cell carcinoma Hong Kong (Kwong Wah Hospital) • Spindle cell carcinoma Saudi Arabia (King Fahad National Guar.d Hospital) - High grade sarcoma favoring synovial sarcoma Saudi Arabia (King Faisal Special!)' Hospitall . - Sarcomatoid carcinoma vs. synovial sarcoma, right maxilla United Kingdom (John Radcliffe Hospital) - Sarcomatoid carcinoma

10 CITR. March 2008 "Minutes" (Sub:scriplion A)

CaJe 9- Diagnosi$:: High grade spindle cell malignancy, favor monophasic synovial sarcoma over spindled carcinoma, maxilla

1'·10170, M-9041l

Directors Note: "Note the organized fasclcuhtr growth pattem nnd vascularity mimicking ~tal of nn HPC" (dre)

Case 9- References: Paulino A C. Synovial SarcomaPrognoslic Factor.; and PancrnsofFailun:. AmJ Clln Om-o/2004; 27(2):122-127. Guillou L, Benhanar J, et al. Histologic Grade, But Not SYT·SSX FUsion Type, Is An lmponant Prognostic Factor in

Patients with Synovial Sarcoma. A Multicenter, Retrospective Analysis. J Clin Onco/2004; 22(20):4040-4050. Jordan RC and Regozi JA. Oral Spindle Cell Neoplasms. A Review of 307 Cases. Oral Surg Oral Med Oral Pathol

Oral Radio/ Endod2003; 95(6):7 17-724. Mathur S, Kapiia K and Venna K. Accuracy of Cytological Grading of Spindle-Cell Sarcomas. Dlagn Cytopathol

2003; 29(2):79-83. Ewing CA, Zakowski MF and Lin 0 . Monophasic Synovial Sarcoma. A Cytologic Spectrum. Dlagn Cyroparho/2004;

30(1):19-23. Coindre JM, Pclmus M, Hostein I, cr al. Should Molecular Testing Be Required For Diagnosing Synovial Sarcoma? A

Prospective Study of204 Cases. Ca11cer 2003; 98(12):2700-2707.

Case No. I 0, Accession No. 30550 March 2008

Alameda (Alameda County Medical Ceoterl - Granulosa cell tumor Long Beach (Long Beach VA Hosphn!l - Granulosa cell tumor (6) Oakland • Sex cord tumor Oxnard fSL John's Re&ional Medical Center> · Sex cord tumor San Diego - Granulosa cell tumor, ovary San Diego (Naval Medical Center) - Granulosa cell tumor Santa Rosa Memorial Hospital) - Senol cell rumor, annular tubular type (sex cord tumor with annular tubules) ( i);

Granulosa cell tumor (2) Woodland Hills • Granulosa cell tumor Alabama (Baptist Medjcal Center) • Granulosa cell tumor Alabama (St. Vincent's Hospital) - Granulosa cell tumor Alabama fUABl • Granulosa cell rumor Colorado - Sex cord rumor with annular tubules florida (The Pathology Group) • Adult granulosa cell rumor Georgia (Medical College of Georgia) • Granulosa cell tumor lndjana (St. Joseph Hospital) - Adult granulosa cell tumor (I); Granulosa cell tumor (I) Iowa (Winneshiek County Medical Hosojl!!!l - carcinoid tumor Mprvland (Washinglon DC Group) - Sex cord rumor with annular tubules Massachusetts ITufis-New England Medical Center) - Adult granulosa cell rumor Mjssouri (Missouri Delta Medical Ccmerl - Adult granulosa cell rumor Neyada (Sunrise 1-!ospjta)) • Adult granulosa cell tumor New York (Long Island Jewish Medical Center) - Granulosa cell tumor New York (SL Lukc's-Roosevelt Hospjta!l • Granulosa cell tumor New York (Stony Brook Universirv Medical Center) - Adult granulosa cell tumor Ohio (St. Elizabeth Health Center) - Granulosa cell tumor Pennsylvania (Magee Women's Hospital) - Granulosa cell tumor Australia <Royal Hoban Hospital) - Adult granulosa cell tumor lions Kong (Kwong Wah Hospita!l - Adult granulosa coli rumor Saudi Arabia (King Eahad National Gyard Hospital) - Granu losa cell tumor Saydi Arabia O<jng Eaisal Specialty Hospital) - Sex cord siJ'Omaltumor with annular tubules, ovary Uojtcd Kingdom Uohn Radcliffe Hosoita!l • Granulosa cell tumor

CTTR. Mudl2008 "Minuta- (Subscrip<ion A) II

Cas< 10- Diagnosis: Granulosa cell tumor, ovary

T-87000, ~-86203

Case I 0 - References: Chu S, Alcxiadis M and Fuller PJ. Expression, Mutational Analysis and In Vitro Response oflmatinib Me.sylateand Nilotinib Target

Genes in Ovarian Granulosa Cell Tumors. Gynecof Qnco/2008; 108( 1): 182-1 !)0. Lee YK, Park NH. Kim JW, et al. Characteristics ofRccurrcnc'e in Adui!-Type'Granulosa Cell l 'umor. lnt J Gynecol Cancer 2007. Farinola· MA, Gown AM. Judson K. ¢t a1. Estrogen Receptor Alpha and Progesterone Receptor Expression in Ovarian Adult

Granulosa Cell Tumors and Scrtoli-L<:ydig Cell Tumors. lnt J Gyneco/ Patho/2001; 26(4):375-382. Mehta .A, Trivedi P, Parikh B .• et al. Clinicopathological Prognostic Factors of Adult Granulosa Cell Tumor of the Oval)'. A Study

of 37 Cases. lnd J Pat hoi Microbio/2005; 48(4):439-443. Crew KD, Cohen MH, Smith DH, ct al. Long Natural History of Recurrent Granulosa Cell Tumor of the Ovary 23 Years After

Initial Diagnosis. A Ca.<e Report and Review of the Literature. Gxnecol Onco/ 2005; 96(1):235-240. McCiuggagc WG and Young RH. immunohistochemistry as a Diagnostic Aid in the Evaluation of Ovarian Tumors. Semln Diag,r

Patlzo/2005; 30-32.

12 CITR, March 2008 "'Minures'' (Subscription t\)